Breaking down the myths about diabetes

CORPUS CHRISTI - I've been an observer of diabetes care for decades, both as a patient and a diabetes doctor.

One thing that continues to capture my attention is the amount of diabetes mythology, perpetuated by patients and health care providers alike.

People often turn to a health care provider as an authority in just about every subject under the sun. Although virtually every health care provider will encounter a patient with diabetes during their career, this does not make them an authority on the subject.

It's with this backdrop that many myths flourish. Let me use this to explain some of the more common myths.

Simply stated, diabetes is an inability to control blood sugar levels. This can be permanent and it can be temporary. How to make the diagnosis of diabetes is well-defined, but may not always be followed to the letter when a health care provider says "you have diabetes."

Remember, with the handful of minutes you might have with a doctor, they must process your story and any lab work, perform an exam and make a diagnosis (if one is to be made), then decide on a course of action.

Diabetes is not one disease, but a collection of many diverse causes. Medicine has created labels which oversimplify the matter.

Diabetes exists along a continuum. Some people may be very close to developing high blood sugars but only need a nudge from the effect of certain medications, some extra weight gain, or some severe form of stress to uncover the diabetic state.

Take away those conditions and the problem might go away. Sadly, it may only be for a while. The situation that temporarily uncovered it could be looked upon as a warning to make changes to either prevent it or at a minimum discover it early.

Many of the other myths about diabetes simply arise from a general lack of knowledge of the nuances of the disease. For example, most people with Type 2 diabetes don't realize that their condition is progressive and that the loss of the ability to make their own insulin goes away at a rate of about 4 percent a year. Eventually, this means that many with Type 2 diabetes will need to take insulin to survive.

Anyone with what we call Type 1a diabetes (the type that I have), always will require insulin to survive long-term. There are no pills yet that can replace insulin.

Recently, with the aggressive use of surgical weight loss there are claims made of reversing diabetes. In some cases, the diabetic state can revert to a non-diabetic pattern if the surgery is done early enough and weight loss is in the range of 10 percent to 20 percent of starting weight.

But what is often forgotten is that the person with Type 2 diabetes who gets surgical weight loss therapy already has lost more than half of their lifelong capacity to make insulin. The weight loss reduces the insulin demand of the body. What we still don't know is: for how long?